The Neuropathic Foot Flashcards Preview

PTRS 746 Exam 1 > The Neuropathic Foot > Flashcards

Flashcards in The Neuropathic Foot Deck (37):
1

Q: What % of those with diabetes will develop neuropathy?

50%

2

T/F: Neuropathy is implicated in 25% of non-traumatic amputations.

False, 50-75%

3

Q: What are the mortality rates 1 and 5 years after amputation?

40%, 80%

4

Content: Causes of neuropathy (6)

1. Diabetes

2. Tumor, trauma

3. Autoimmune disease

4. Vitamin B, E, niacin deficiency

5. Exposure to toxins

6. Infection

5

Content: 4 types of neuropathy 

1. Peripheral - UE/LE

2. Autonomic - CVS, temp reg, bowel/bladder

3. Proximal - thigh, hip, core mm

4. Focal - sudden loss in one n. or group of n.

6

Content: Foot Examination (3)

1. comprehensive foot exam should be completed at LEAST annually

2. those with neuropathy should have feet visualized every medical visit

3. those with diabetes should check their feet each day 

 

7

Content: Goals of the foot exam (4)

1. Est. history/diagnostic factors

2. Identify risks

3. Intervention

4. Education 

8

Q: _________ involvement in foot neuropathy is __________.

Early, crucial

9

Q: What habit can increase your risk of neuropathy?

smoking (current or past)

10

Content: SE for foot neuropathy (7)

1. Contributing diagnosis

2. PMH/social factors

3. Medications

4. Complications

5. Hx of LE surgery, ulcer, amputation

6. Current or past smoker

7. HbA1c (diabetes)

11

Content: OE for foot neuropathy (5)

1. Condition of skin, hair, toenails

2. Deformities

3. Pulses

4. Sensation

5. Shoe wear

12

Content: Skin (3)

1. Think, shiny, brawny and/or frail

2. Dry

3. Calluses/wounds

13

Content: Hair

May be present or absent

14

Content: Toenails (3)

1. Thickened

2. Deformed

3. Ingrown

15

Content: Four neuropathy deformities (4)

1. Prominent metatarsal heads

2. Hammer/claw toes

3. Hallux Valgus/bunions

4. Charcot Foot

16

Diagram: Identify the Deformity

Q image thumb

Claw toes

17

Diagram: Identify the Deformity

Q image thumb

Hammer toe

18

Diagram: Identify the Deformity

Q image thumb

Upper = corn

Lower = callus

19

Diagram: Identify the Deformity

Q image thumb

Hallux Valgus

20

Content: Charcot Arthropathy (4)

1. Progressive bone destruction and ligament damage leading to arch colllapse and impaired skin integrity

2. Affects abot 9% of those with diabetes

3. Unclear if etiology is neurotraumatic, neurovascular, or both

4. Generally treated with complete immbolizations in a total contact cast with protected WB

21

Q: What 3 pulses should you check during a foot exam?

1. Posterior tibilais

2. Dorsal pedis

3. Ankle brachial index (ABI)

22

Cotent: ABI Scale (6 parts)

> 1.2 = vessels are incompressible, consider toe brachial indexes

1.0-1.2 = normal

0.9-0.99 = acceptable

< 0.9 = arterial disease

0.5-0.8 = intermittent claudication

< 0.5 = severe arterial disease

23

Content: Sensation assessment (2)

1. Semmes Weinstein Monofilament (10 locations)

2. Vibratory sensation (128 Hz tuning fork, latency > 10 sec = sensory loss)

24

Content: Assessment - Low Risk Foot Neuropathy (4)

1. Preserved sensation

2. No defromity

3. Intact circulation

4 Tx: Annual foot exam, education, good footwear

25

Content: Assessment - High Risk Foot Neuropathy (6)

1. Sensory loss

2. Deformity

3. Vascular disease

4. Callus formation 

5. Hx of ulcer or amputation

6. Tx: comprehensive assessment, education, diabetic shoe

26

Content: Education (4)

1. General diabetes self care

2. Foot/skin care

3. Daily skin checks

4. Proper footwear (breathable, adjustable, wide toe box, good support)

27

Content: Ulcer intervention (4)

1. Debulk callus

2. Control moisture

3. Decrease infection risk 

4. Edema management

28

Content: Offloading (5)

1. Total contact casts (change ever 1-2 wks)

2. Orthotics/walking boots

3. Surgical shoes

4. Dressings

5. Cutouts

 

29

Q: How should you elevate a pts. heels?

With pillow under calves

30

Content: Foot Care Education (6)

1. Check feet daily

2. ALWAYS wear shoes

3. No lotion/oil between toes

4. Keep nails clipped

5. Manage calluses

6. Report changes immediately

31

Content: Exercise recommendations for foot neuropathy

At least 30 min most days - consider foot integrity

32

Content: Nutrition recommendations for foot neuropathy (4)

1. Montior BMI - stable or weight loss

2. Fresh fruits/veggies

3. Pre meal glucose 90-130 mg/dl

4. Post meal glucose 180 mg/dl

33

Content: glycemic control recommendations for foot neuropathy

HbA1c goal of < 6.5-7

34

Q: What is HbA1c?

Average blood sugar over a peroid of 3 months

35

Q: Who could you refer pts. with foot neuropathy to? (4)

1. Podiatry

2. Wound care

3. Nurse educator 

4. Dietician

36

Defn: Claw toe

Hyper extension of MTP with PIP/DIP flexion

37

Defn: Hammer toe

Hyperextension of MTP and DIP